Neoadjuvant hormone therapy for patients with high-risk prostate cancer: a systematic review and meta-analysis

被引:19
作者
Liu, Wen [1 ]
Yao, Yu [1 ]
Liu, Xue [2 ]
Liu, Yong [1 ]
Zhang, Gui-Ming [1 ]
机构
[1] Qingdao Univ, Affiliated Hosp, Dept Urol, Qingdao 266003, Peoples R China
[2] Qingdao Univ, Affiliated Hosp, Dept Anesthesiol, Qingdao 266003, Peoples R China
基金
中国国家自然科学基金;
关键词
ANDROGEN DEPRIVATION THERAPY; RADICAL PROSTATECTOMY; RANDOMIZED-TRIAL; RADIOTHERAPY; MEN; SUPPRESSION; RADIATION; ADJUVANT; SURVIVAL; QUALITY;
D O I
10.4103/aja.aja_96_20
中图分类号
R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
摘要
This study aimed to identify the pathological outcomes and survival benefits of neoadjuvant hormone therapy (NHT) combined with radical prostatectomy (RP) and radiotherapy (RT) administered to patients with high-risk prostate cancer (HRPCa). We searched PubMed, Embase, and the Cochrane Library for studies comparing NHT plus RP or RT with RP or RT alone, administered to patients with HRPCa. We used a random-effects model to compute risk estimates with 95% confidence intervals (CIs) and quantified heterogeneity using the I2 statistic. Subgroup and sensitivity analyses were performed to identify potential sources of heterogeneity. We selected 16 studies. NHT before RP significantly decreased lymph node involvement (risk ratio [RR] = 0.69, 95% CI: 0.56-0.87) and increased the rates of pathological downstaging (RR = 2.62, 95% CI: 1.22-5.61) and organ-confinement (RR = 2.24, 95% CI: 1.54-3.25), but did not improve overall survival and biochemical progression-free survival (bPFS). The administration of NHT before RT to patients with HRPCa was associated with significant benefits for cancer-specific survival (hazard ratio [HR] = 0.51, 95% CI: 0.39-0.68), disease-free survival (HR = 0.51, 95% CI: 0.44-0.60), and bPFS (HR = 0.54, 95% CI: 0.46-0.64). Short-term NHT combined with RT administered to patients with HRPCa conferred significant improvements. Although the advantage of local control was observed when NHT was administered before RP, there was no significant survival benefit associated with HRPCa. Therefore, short-term NHT combined with RT is recommended for implementation in standard clinical practice but not for patients who undergo RP.
引用
收藏
页码:429 / +
页数:14
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